Provider Demographics
NPI:1245299114
Name:CARERESOURCE HAWAII
Entity type:Organization
Organization Name:CARERESOURCE HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKASUGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-599-4999
Mailing Address - Street 1:680 IWILEI RD
Mailing Address - Street 2:SUITE 660
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5388
Mailing Address - Country:US
Mailing Address - Phone:808-599-4999
Mailing Address - Fax:808-531-2832
Practice Address - Street 1:680 IWILEI RD
Practice Address - Street 2:SUITE 660
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5388
Practice Address - Country:US
Practice Address - Phone:808-599-4999
Practice Address - Fax:808-531-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
HIHHA-16251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50601600OtherALOHACARE QUEST
HI506016-01Medicaid
HI533275-02Medicaid
HI533275-04Medicaid
HI533275-03Medicaid
HI533275-05Medicaid
HI12-7013OtherOTHER MEDICARE PFFS/HMO
HI12-7013AOtherALOHACARE ADVANTAGE
HI533275-01Medicaid
HIA002543-5OtherHMSA (PRIVATE INSURER)
HI533275-04Medicaid
HI533275-03Medicaid